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Early Use of Low Residue Diet Is Superior to Clear Liquid Diet After Elective Colorectal Surgery: A Randomized Controlled Trial

Lau, Cheryl MD*; Phillips, Edward MD, FACS; Bresee, Catherine MS; Fleshner, Phillip MD, FACS, FASCRS*

doi: 10.1097/SLA.0000000000000929
Papers of the 134th ASA Annual Meeting

Objective: Compare the feasibility and patient tolerance to either a clear fluid (CF) or low residue diet (LRD) started on postoperative day (POD) 1 after elective colorectal surgery.

Background: Diet advancement after surgery traditionally starts gradually with liquids, on the basis of fears that early solid intake may increase nausea, vomiting, and overall complications. A randomized controlled trial comparing LRD and CF on POD 1 was performed.

Methods: 111 elective colorectal surgery patients were randomized to CF (n = 57) or LRD (n = 54). The primary end point was vomiting on POD 2. Secondary endpoints included nausea score, days to flatus, length of hospital stay (LOS), and postoperative morbidity.

Results: Patient characteristics, surgical technique, intraoperative characteristics, and postoperative opioid use were similar between study arms. CF versus LRD results were as follows: POD2 vomiting (28% vs 14%; P = 0.09), and significant increase in mean nausea score (4.7 vs 3.5; P = 0.01), days to flatus (4.8 vs 3.7 days; P = 0.04), and LOS (7.0 vs 5.0 days; P = 0.01). LOS remained significantly shorter even after adjusting for significant covariates (laparoscopic technique, surgical site, postoperative comorbidity, stoma, and nasogastric tube) with LRD patients having an adjusted 1.4-day decrease in LOS (P < 0.01). There was no significant difference in postoperative morbidity between study arms. Multivariate analysis of all secondary endpoints confirmed an overall significant improvement in outcomes for LRD vs CF (P < 0.01).

Conclusions: LRD, rather than CF, on POD1 after colorectal surgery is associated with less nausea, faster return of bowel function, and a shorter hospital stay without increasing postoperative morbidity.

A randomized controlled trial comparing clear liquid diet versus low residue diet (LRD) on postoperative day 1 of elective colorectal surgery showed superior outcomes in the LRD arm. LRD arm patients had less nausea, faster time to first flatus, and shorter length of stay without increasing morbidity.

*Division of Colorectal Surgery

Department of Surgery; and

Biostatistics and Bioinformatics Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.

Reprints: Phillip Fleshner, MD, FACS, FASCRS, Division of Colorectal Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048. E-mail:

Disclosure: The authors have no conflict of interest.

Podium presentation at the 134th Annual Meeting of the American Surgical Association, April 11, 2014, Boston, MA.

© 2014 by Lippincott Williams & Wilkins.